J Patrick Slifka LCSW amp George Young LCSW Why Were Here Dealer out of Business httpwwwyoutubecomwatchvCb93lPJB8yw Which is More Dangerous httpwwwyoutubecomwatchvunCqak6mYQ ID: 334375
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Slide1
Prescription Drug Abuse: Loosening the Knot
J. Patrick
Slifka
, LCSW & George Young, LCSWSlide2
Why We’re HereSlide3
Dealer out of Business?
http://www.youtube.com/watch?v=Cb93lPJB8ywSlide4
Which is More Dangerous?
http://www.youtube.com/watch?v=u_nCqak6mYQSlide5
“Just The Facts”
All of these drugs are available – right now.
They do what they’re “advertised to do.”
If your individuals (particularly your adolescent ones) have not been already, they will soon be in a position to make a choice…to use or not to use. Their choice will carry both a benefit and a consequence. Slide6
“Just The Facts”
Drugs are not
inherently
evil, bad, or good – they’re simply chemicals.The Relationship a person forms with a drug becomes the problem – and the problem gets progressively and significantly worse over time.Remember that not all individuals have the same responses to the same drug or class of drugs. There are idiosyncratic reactions we have to assess and understand.Slide7
Why We’re Here?
Epidemic? Problem?
Attitude is the father of the ActionEthical Obligation and Competent PracticeSlide8
Jeopardy TimeSlide9
Jeopardy Question #1
The Answer is:
Patients leave a doctor’s office with this on 7 out of every 10 visits.
What is a Prescription?Slide10
Jeopardy Question #2
The Answer is:
Medicine Cabinets
Where do a large number of teens who abuse prescription medications get their drugs?Slide11
Jeopardy Question #3
The Answer is:
Dr. Gregory House and American High School Seniors identify this prescription drug as their favorite.
What is Vicodin?Slide12
Trends and Statistics
The LandscapeSlide13
A View of the Landscape
http://www.youtube.com/watch?v=1sdFRJtzI0sSlide14Slide15
Rates of Rx drug sales, deaths and substance abuse
tx
admissionsSlide16Slide17Slide18Slide19Slide20Slide21
1 in 6 TeenagersSlide22Slide23
Most Commonly Abused Medications Among U.S. High School Seniors (2010 Annual Prevalence)
Source: Monitoring the Future, University of Michigan, December 14, 2010Slide24Slide25Slide26
What is Driving the Prevalence?
Misperceptions about safety.
Increasing e
nvironmental availabilityVaried motivations for their abuse.Slide27
Other Factors Driving Trend: Pill-Taking Society
Rx medications are all around us…and teens notice.
Patients leave the doctor’s office with a prescription in hand in 7 out of 10 visits.
Direct-to-consumer advertising on TV and in magazines.
Many people don’t know how to safely use these medications or ignore their doctor’s instructions.
Slide28
Common Prescription Drugs of Abuse
Signs, Symptoms and
Biopsychosocial
ConsequencesSlide29
Top 10 Most Dangerous Drugs in America (DAWN database of ER visits)
Xanax
Oxycontin
VicodinMethadoneKlonopin
Ativan
Morphine Drugs (opiates)
Seroquel
(Antipsychotic)
Ambien
ValiumSlide30
Most Commonly Abused Classes of Prescription Drugs
Opioid Pain Relievers (Opiates, Narcotics)
CNS Stimulants (primarily those used in the
tx of ADHD)CNS Depressants (Sedatives, Hypnotics, Anxiolytics)Slide31
Key Assessment Point: Effects of Drugs Depend on…
Route of administration
Amount taken at one timeUser’s past drug experience
Circumstances under which the drug is taken (the place, the user’s psychological and emotional stability, the presence of other people, simultaneous use of alcohol and other drugs, etc.)Slide32
Commonly Abused Rx Drugs
How they work
Abused to
Drug names
Strong Pain Relievers
Used to relieve moderate-to-severe pain, these medications block pain signals to the brain
To get high, increase feelings of well being by affecting the brain regions that mediate pleasure
Vicodin
,
OxyContin
,
Percocet,
Lorcet
,
Lortab
,
Actiq
,
Darvon, Codeine, Morphine,
Methadone
Stimulants
Primarily used to treat ADHD type symptoms, these speed up brain activity causing increased alertness, attention, and energy that comes with elevated blood pressure, increased heart rate and breathing
Feel alert, focused and full of energy—perhaps around final exams or to manage coursework, lose weight
Adderall
, Dexedrine
Ritalin,
Concerta
Sedatives or tranquilizers
Used to slow down or “depress” the functions of the brain and central nervous system
Feel calm, reduce stress, sleep
Valium,
Xanax
,
Ativan
,
Klonopin
,
Restoril
,
Ambien
,
Lunesta
,
Mebaral
, Nembutal, SomaSlide33
Opioid Pain Relievers (Opiates/Narcotics)Slide34
What are Opiates?
Opiates are a group of drugs that are used for treating pain. They are derived from opium which comes from the poppy plant.
Opiates
go by a variety of names including opiates, opioids, and narcotics. The term opiates is sometimes used for close relatives of opium such as codeine, morphine and heroin, while the term opioids is used for the entire class of drugs including synthetic opiates such as Oxycontin
.
But
the most commonly used term is opiates
.Slide35
Dried Opium PoppySlide36
Commonly Used & Abused Opiates
Opium
Codeine …anybody you’re working with taking any of these?
MorphineTramadol (Ultram)MethadoneBuprenorphine (Subutex)Propoxyphene (Darvocet)
Pethidine
(Demerol)
Hydrocodone (
Lortab
/
Vicodin
)
Oxycodone (Percocet,
Oxycontin
)
Hydromorphone
(
Dilaudid
)
Oxymorphone
(
Opana
)
Fentanyl
Heroin (diacetylmorphine)Slide37
Most Rx’d
Opiate in AmericaSlide38
OxycontinSlide39
Opiates
Opiates are highly effective in controlling moderate to severe pain, but they also have a downside. Opiates are highly
addictive…and
once a person starts abusing them he/she generally becomes dependent (addicted) to them.Slide40
Opiate Effects
Feelings of Euphoria
Suppression of Pain
Depressed Respiratory RateLowered Heart Rate and Blood PressureLethargy/Drowsiness
Clouded Mental Functioning
Nausea/Vomiting
Lowered Body Temperature
Muscle and Bone Pain
Physical/Psychological Dependence
Severe Withdrawal Symptoms
Mood Swings
Severe Constipation
Unconsciousness
Coma
Death by OverdoseSlide41
Opiates: Long Term Effects
Cause significant changes to the nerochemical, molecular and cellular levels.
Changes brain structure and functioning that lasts well beyond the substance use.
These changes are part of what can trigger drug cravings years after last use.Slide42Slide43
How Do Opiates Work?
Opiates
elicit their powerful effects by activating
opiate receptors that are widely distributed throughout the brain and body. Once an opiate reaches the brain, it quickly activates the opiate receptors that are found in many brain regions and produces an effect that correlates with the area of the brain involved.Slide44
How Do Opiates Work?
Two important effects produced by opiates, such as
morphine, are pleasure (or reward) and pain relief. The brain itself also produces substances known as
endorphins that activate the opiate receptors. Research indicates that endorphins are involved in many things, including respiration, nausea, vomiting, pain modulation, and hormonal regulation.Slide45
Opiate Agonists
Opiate agonists are drugs that
stimulate the opioid receptors in the brain
, leading to the high associated with opiate drugs. They include Heroin, Vicodin, Morphine, Codeine and Methadone.They mimic the effects of naturally-occurring endorphins in the body, and produce an opiate effect by interacting with the opioid receptor
sites.Slide46
Opiate Antagonists
Opiate antagonists block the brain’s opioid receptors, making it impossible for opiate drugs to stimulate them. For example, drugs like
Naloxone
and Naltrexone make it so that, if the user were to take a drug like heroin afterwards, there would be no high. These medications are often used to combat the overdose effects of an opiate or to help break an addiction.Slide47
Partial Opiate Agonists
Partial opiate agonists are drugs that have a “ceiling effect.” In other words, they can only stimulate the opioid receptors to a certain extent.
Buprenorphine,
the main ingredient in Suboxone, is one of these. No matter how much Suboxone you take, its effects are limited.Slide48
Sedatives, Hypnotics, and AnxiolyticsSlide49
Sedatives, Hypnotics and Anxiolytics
Drugs that reversibly depress the activity of the central nervous system.
Barbiturates, Benzodiazepines
, and other sedative-hypnotics have diverse chemical and pharmacological properties that share the ability to depress the activity of all excitable tissue, especially in the arousal center of the brainstem.Barbiturates (Sedatives): Amytal, Nembutal,
Seconal
and Phenobarbital.
Benzodiazepines
(Anti-Anxiety):
Ativan, Halcion, Librium, Valium, Xanax, and Rohypnol.
Other Sedative-Hypnotics
(Sleep Inducers):
Lunesta
, Sonata, Ambien.Slide50
Barbiturates
In therapeutic doses, barbiturates are effective and are typically used for seizure disorders and anesthesia. Using them to “get high” is extremely dangerous because there is a relatively small difference between the desired dose and an overdose.
A small miscalculation, which is easy to make, can lead to coma, respiratory distress (breathing slows or stops) and death.
Withdrawal from barbiturates is similar to, and sometimes more severe than, alcohol withdrawal. Seizures are possible and can also lead to death.Slide51
Common Barbiturates
Amytal
NembutalSeconal
Phenobarbital Seconal 100mgA barbiturate may be prescribed for a variety of reasons, the list is extensive, but the most common use today is as an anesthesia for surgery. This form is hardly ever abused because they cause almost immediate unconsciousness.
Other
forms like Phenobarbital are used in treating various seizure disorders as an anticonvulsant. Other uses of this form of barbiturate along with
mephobarbital
include treating anxiety, insomnia, epilepsy and delirium tremens. Slide52
Benzodiazepines
The
benzodiazepine family of depressants is used therapeutically to produce sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent seizures. In general, benzodiazepines act as
hypnotics in high doses, anxiolytics (anti-anxiety) in moderate doses, and sedatives in low doses.
Of
the drugs marketed in the United States that affect central nervous system function, benzodiazepines are among the most widely prescribed
medications.
Compared to barbiturates,
benzodiazepines
are much safer. They cause sedation but rarely stop a person’s breathing or lead to death (unless combined with other CNS depressants).Slide53
Common Benzodiazepines
Ativan
HalcionLibrium
RestorilValiumXanaxRohypnol (not marketed in U.S.)Slide54
Other Sedative-Hypnotics: Sleep Aids
This is a newer class of drugs that is used for the short-term treatment of insomnia. They cause the onset of sleep to occur faster and allows for a longer sleep period throughout the night
.
These non-benzodiazepines have a short half-life and have less chance of causing dependency, tolerance, and impairment of daytime activities due to carry-over effects
.
Again, combining any of these drugs or using them with alcohol (and other depressants) can lead to dangerous effects.Slide55
Common Sleep Aids/Hypnotics
Ambien/Ambien CR
SonataRozerem
PrecedexLunestaSlide56
CNS StimulantsSlide57
CNS Stimulants
CNS Stimulants are a class of drugs that elevate mood, increase feelings of well-being and increase energy and alertness. Examples include:
Caffeine *Amphetamines Cocaine
Methamphetamine
“Bath Salts”Slide58
Amphetamines
Synthetic psychoactive CNS stimulant drugs including amphetamine,
dextroamphetamine and methamphetamine
Medications containing amphetamines are prescribed for narcolepsy, obesity and ADHD (including Adderall, Dexedrine, DextroStat, and Desoxyn). The basic molecule of amphetamine can be modified to emphasize specific actions (e.g., appetite suppressant, CNS stimulant, cardiovascular actions) for certain medications…including methylphenidate (Ritalin and
Concerta
).Slide59
DexedrineSlide60
RitalinSlide61
AdderallSlide62
Adderall: The “Study Pill”
http://www.youtube.com/watch?v=1gQNg2f15dkSlide63
Amphetamines
Cause release of the neurotransmitters dopamine and norepinephrine – and their reuptake is inhibited.
This influx causes the buildup of NTs at synapses in the brain.
When mixed with other drugs (including alcohol), the effects of prescription amphetamines are enhanced. When the drug is snorted, effects occur within 3-5 minutes. When ingested orally, effects occur within 15 to 20 minutes.Slide64
Amphetamines: Short-Term Effects
Increased activity/talkativeness
Decreased fatigue/drowsiness
Heightened sense of well-beingHeightened alertness/energyEuphoriaRelease of social inhibitionsAltered sexual behaviorUnrealistic feelings of cleverness, great competence, and powerHostility or paranoia
Increased body temperature
Irregular or increased heart rate
Increased diastolic/systolic BP
Decreased appetite
Dry mouth
Dilated pupils
Increased respiration
Nausea
Headache
Palpitations
Cardiovascular system failure
Twitching/Tremor of small musclesSlide65
Amphetamines: Long-Term Effects
Toxic psychosis
Physiological and behavioral disorders
DizzinessPounding heartbeatDifficulty breathingMood/Mental changesUnusual tiredness/weaknessCardiac arrhythmiasRepetitive motor activity
Ulcers
Malnutrition
Mental Illness
Skin disorders
Vitamin deficiency
Flush or pale skin
Loss of coordination and physical collapse
Convulsions, coma and death.Slide66
Amphetamines: Potential for Abuse
Rx amphetamines are taken orally and in low doses, drug abuse and addiction are not serious risks.
Abuse of amphetamines can lead to tolerance and physical/psychological dependence characterized by consuming increasingly higher dosages and by the “binge and crash” cycle.
When the binge episode ends, the abuser “crashes” and is left with severe depression, anxiety, extreme fatigue, and a craving for more drugs. The chronic abuse of amphetamines is characterized by erratic (sometimes violent) behavior – as well as a psychosis similar to schizophrenia.Slide67
Screening and EvaluationSlide68
Screening & Assessment: 3 Primary Goals
1. To Obtain Information/Collect a Database
2. To Determine Eligibility for a Particular Service
3. To Engage the Individual/Family in the Treatment
ProcessSlide69
The Clinical Assessment Interview: Basic Elements
Only
One
part of a multimodal evaluationFormally arranged meetingHas specific purposeInterviewer chooses topic/broad contentDefined relationships
Interviewer attuned to ALL aspects of interaction - Affect, Behavior, Style (Process) and Content
Questioning techniques/strategies employed to direct the flow of conversation
Acceptance of client's expressions of feelings and factual information without casting judgment
Interviewer makes explicit what otherwise be left unstated
Assessor follows guidelines for confidentiality and disclosure of info.Slide70
What a Clinical Assessment Interview is NOT...
Ordinary Conversation
"Counseling" Session
Forensic InterviewSurvey InterviewSlide71
The Assessment Interview: Assumptions
1. Need for Multiple Data Sources:
There is no gold standard for assessing people's functioning. The key to good assessment is to find the conceptual links and relationships between methods and modalities of the assessment. Each form of indirect and direct methods contributes unique elements to solving the puzzle (Wheel of Fortune).Slide72
Assumptions (Cont.)
2. Situational Variability:
Individuals' behaviors are likely to vary across situations and relationships. Good assessment requires identifying patterns of behavior that DIFFER across situations and relationships as well as patterns that REMAIN CONSISTENT, despite variations in situations and relationships.
Slide73
Assumptions (Cont.)
3. Limited Cross-Informant Agreement:
There is likely to be only low-to-moderate agreement between informants who are in different situations or in different relationships with the same person (esp. children). Low agreement does not mean that one is right and one is wrong or that one has a "truer" picture. The challenge is to put all these pieces together to form a meaningful picture of the person's functioning under the given circumstances.Slide74
Assumptions (Cont.)
4. Variations in Interview Structure and Content:
The structure and content of clinical interviews should vary in relation to the informant and the goals of the interview. Structured, semi-structured, direct observation, indirect data collection, age/role appropriateness, etc. Clinical interviews need to be tailored to particular informants. The content and questioning strategies are shaped by the kind of informant interviewed and the kind of information sought.Slide75
Interview Content and Questioning Strategies
1.
Semi-Structured:
Questions used to query client (and others) about many aspects of functioning. Format is relatively open-ended and flexible to stimulate a natural flow of conversation. MI strategies are used (empathy, reflective listening, summarizing). Probe questions can then be used to obtain more detailed information.
2.
Structured:
Appropriate for querying individuals/family members about symptoms and criteria for psychiatric disorders. Structured diagnostic interviews have a standardized set of questions and probes focusing on specific problems relevant to diagnoses.Slide76
Interview Content and Questioning Strategies (Cont.)
3.
Behavior-Specific:
Questions can be used to query family members parents, teachers, PO's, etc. regarding their current concerns about the individual. More narrow in scope than semi-structured because the focus is on a limited number of specific problem areas. Typically, the main purposes
are:
a) identify and define problems of concern of others (
problem identification
)
b) examine antecedents and consequences that surround the identified problems (
problem analysis
)
Assessors can also use behavior-specific questions to elicit from individuals their views of particular problems and their understanding of the consequences around the problems.Slide77
Interview Content and Questioning Strategies (Cont.)
4.
Problem-Solving:
Focus on others' current concerns with the goal of developing interventions for identified problems. In initial clinical interviews, assessors can use problem-solving questions to explore and gauge others' receptivity to different kinds of interventions prior to implementing any interventions.
Can also use problem-solving questions to explore individual’s views of different interventions and to find out which approaches are acceptable to them.Slide78
Preparation: Master Your Material
Preparation and Mastery increase your confidence and competence. Your goals include...
Understanding and applying all aforementioned material
Learning and knowing intimately all sections (and the purpose for each) of the assessment formsMastering the art of Motivational InterviewingReading, Studying, Understanding DSM-IV/DSM-5 diagnostic criteria - and applying structured interviewing strategies to rule out and rule in dx
Knowing what you don't know - and learning itSlide79
Preparation and Mastery: Conceptualizing Your Case
Guided by: Observing, Questioning, Thinking
(repeat ad
nauseum)Study your prelim. Info (Screening Form, etc.) and apply the above...Begin your studies/researchGenerate Questions
Formulate Hypotheses (not conclusions)
Prepare, Prepare, Prepare...
Slide80Slide81
Key Terms
Tolerance:
(a) a need for markedly increased amounts of the
substance to achieve intoxication or desired effect. (b) markedly diminished effect with continued use of the same amount of the substance (DSM-IV TR).
Potentiation:
Potentiation occurs when two drugs are taken together and one of them
intensifies
the action of the other.
This
could be expressed by
a +b= B.
As an example, - an
antihistamine, when given with a painkilling
narcotic
such as
Percocet ,intensifies
its
effect thereby
cutting down on
the
amount of the narcotic needed.
Slide82
Key Terms
Cross Tolerance and Cross Dependence:
Cross
tolerance refers to the fact that if a person has developed a tolerance to a drug in a certain classification, such as the depressants, that person is more likely to develop tolerance with another drug in that classification.
As
an example, people who are dependent upon alcohol show an increased tolerance to barbiturates, synthetic and natural opiate narcotics, and anesthetics. This, of course, means that the person must have a higher dose of the new drug for it to be effective.
In
cross dependence
, the withdrawal symptoms from one drug in a classification can be relieved by another
.
As an example, many alcoholics are given barbiturates and tranquilizers to prevent withdrawal symptoms. However, the person may soon develop a dependency on the other drug as well.Slide83
Key Terms
Synergism:
Synergism
is similar to potentiation. If two drugs are taken together that are similar in action, such as barbiturates and alcohol, which are both depressants, an effect exaggerated out of proportion to that of each drug taken separately at the given dose may occur. This could be expressed by 1+1= 5. An
example might be a person taking a dose of alcohol and a dose of a barbiturate. Normally, taken alone, neither substance would cause serious harm, but if taken together, the combination could cause coma or death
.Slide84
Key Terms
Withdrawal:
Withdrawal
is a term referring to the feelings of discomfort, distress, and intense craving for a substance that occur when use of the substance is stopped. These physical symptoms occur because the body had become metabolically adapted to the substance. The withdrawal symptoms can range from mild discomfort resembling the flu to severe withdrawal that can actually be life threatening. Withdrawal from particular substances can be
extremely serious
and
dangerous
(potentially life-threatening). Refer to the DSM-IV TR and or DSM-5 for drug-specific withdrawal profiles.Slide85
Interventions/Best PracticesSlide86
Treatment: Key Components
Established Clinical Model that is evidence-based
Individualized assessment and
person-centered treatment planningFull array of integrated services (MH and SA, etc.)Individual, Family and Group TherapiesPsychoeducationMotivational Interviewing/Motivational Enhancement (strengths-based)
Cognitive-Behavioral Interventions
Relapse and Recovery Planning
Connection and Collaboration with Community Resource and Associated Professionals (wrap-around)
Frequent/randomized drug/alcohol screening
AccountabilitySlide87Slide88Slide89
Drug Testing
Critical Component of any treatment program
Urine lab testingUrine instantOralHairSlide90
Pay Attention! What to “watch” for when conducting drug screens
All testing needs to be
Observed
whenever possible.Dilution – water loading/adding water to samples Flushing – ingesting Niacin or Golden Seal (or any of hundreds of other products on the market)Substituting – synthetic urine or borrowing/storing urine
Mechanical Devices – the “
Wizinator
,” small bottles or tubes Slide91
Screening: Other things to Know
Know where your individuals can get tested (and what kind of testing they conduct)
Know what medications your individuals are taking
Connect with a therapist or doctor that conducts drug screens, or make sure you call the lab toxicologist for specific informationYou do not have to be the expert on all information, but know where to get the information and be willing to puruse it!Slide92
Principles of Effective Treatment (National Institute of Drug Abuse, 2012)
Addiction is a complex but treatable disease that affects brain function and behavior.
No single treatment is appropriate for everyone.
Treatment needs to be readily availableEffective treatment attends to multiple needs of the individual, not just his or her substance abuse.Slide93
Principles of Effective Treatment (cont.)
Remaining in treatment for an adequate period of time is critical.
Behavioral therapies – including individual, family, or group counseling – are the most commonly used forms of drug abuse treatment.
Medications are important element of treatment for many individuals, especially when combined with counseling and other behavioral therapies.Slide94
Principles of Effective Treatment (Cont.)
An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that is meets his or her changing needs.
Many drug-addicted individuals also have other mental disorders.
Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuseSlide95
Principles of Effective Treatment (Cont.)
Treatment does not need to be voluntary to be effective.
Drug use during treatment needs to be monitored continuously, as lapses during treatment do occur.
Treatment programs should test individuals for the presence of HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases as well as provide targeted risk reduction counseling, linking individuals to treatment if necessary.Slide96
ASAM Criteria: Case Conceptualization
Wherever the treatment location or circumstances,
some guidelines
have suggested criteria to consider when treating substance dependence. The following criteria were developed by the American Society of Addiction Medicine (ASAM) to consider in the treatment of dependence:
1. acute intoxication and/or withdrawal potential
2. biomedical conditions and complications
3. emotional, behavioral, or cognitive conditions and complications
4. readiness to change
5. relapse, continued use, or continued problem potential
6. recovery/living environmentSlide97
ASAM Levels of Treatment
ASAM Levels
Level 0.5 = Early Intervention Services
Level 1 = Outpatient Treatment Services(3 hours a week or less)Level 2 = Intensive Outpatient/Partial Hospitalization (9 hours per week at least)
Level 3 = Residential/Inpatient Services (24 Hours/Day)
Level 4 = Medically Managed Intensive Inpatient Services
Reference:
www.asam.org
Slide98
Opiate Withdrawal and DetoxificationSlide99
Opiate/Narcotic Withdrawal
Opiate addicts avoid treatment because they are afraid of withdrawal, which can be rather unpleasant but rarely fatal. They crave the drug and experience muscle and bone pain, insomnia, restlessness, nausea and vomiting, sweating, involuntary muscle twitches, dry mouth.
Opiate withdrawal will usually peak between 48-72 hours after the last use. But withdrawal can last much longer, depending on the individual. Slide100
Detoxification and “Maintenance”
Medications have been developed to lessen the impact of the withdrawal and help addicts rid themselves of the need to use. Principal among these are
Methadone
and Suboxone, both synthetic opiates themselves, but both act to block the impact of the opiates. Slide101
Maintenance Therapy
Maintenance therapy with drugs like methadone or Suboxone is helpful because it takes away the severe effects of a heroin or prescription painkiller habit while easing the symptoms of withdrawal.Slide102
APA Guidelines for Opiate Dependence
The American Psychiatric Association (APA) guideline
identified the following 3 treatment modalities to be effective
strategies for managing opioid dependence and withdrawal:1. opioid substitution with methadone or buprenorphine, followed by a gradual taper2. abrupt opioid discontinuation with the use of clonidine
to suppress
withdrawal symptoms
3. clonidine-naltrexone detoxificationSlide103
Considering Your Options in Dealing with an Opiate Dependent Individual
Acute opioid-related disorders that require medical management include
opioid intoxication,
opioid overdose, and opioid withdrawal. Issues pertaining to treatment of chronic opioid abuse include opioid agonist therapy (OAT), psychotherapy, and treatment of acute pain in patients already on maintenance therapy. Slide104
Intensive Case ManagementSlide105
The Importance of Coordinated Intervention
We need an integrated, coordinated community response focused on recovery. This type of approach is more effective in preventing, treating and managing the chronic consequences of substance abuse and addiction than a response that is fragmented or focused primarily on penalties.
We need a systematic response that is fast, fluid and flexible…meeting needs as they arise and changing through the continuum of care.Slide106
Intensive Case Management and Wrap- Around: Who Needs to be Involved?
The prescribing physician
Significant other(s)
Probation or parole (if a part of the case)Other clinicians (if part of the case)Other “natural supports” (as part of a high-fidelity wrap around team)Please make sure you follow all confidentiality regulations under 42 CFR Part 2.Slide107
Why include these people? What’s the rational?
Liability
Appropriate Service/Treatment Planning
Best PracticeSlide108
Case Study ExerciseSlide109
Case Study: Time to Pick each others’ Brains and Generate some Ideas!Slide110
“Dedicated Service To Those In Need”
Our strong reputation keeps us increasingly committed to providing high quality services to youth and families in the community
.Slide111
Additional References and Resources
www.nationalcounselinggroup.com
American Psychiatric Association. (2000).
Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5
th
ed.). Washington, DC: Author.
Johnston, LD, O'Malley, PM, Bachman, JG, &
Schulenberg
, JE. (2012).
Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings
, 2011. Ann Arbor: Institute for Social Research, University of Michigan. Available at
http://monitoringthefuture.org
.
Levine, DA. (2007). “'Pharming': The abuse of prescription and over-the-counter drugs in Teens.”
Current Opinion in Pediatrics.
Vol. 19, No. 3, pages 270-274
.
National Institute on Drug Abuse. NIDA
InfoFacts
: Prescription and Over-the-Counter Medications.
http://www.drugabuse.gov/infofacts/PainMed.html
). Bethesda, MD: NIDA, NIH, DHHS. Published June 2009. Retrieved February 2012
.
National
Institute on Drug Abuse. NIDA Research Report: Prescription Drugs: Abuse and Addiction.
http://www.drugabuse.gov/ResearchReports/Prescription/Prescription.html
. NIH Publication No. 11-4881. Bethesda, MD: NIDA, NIH, DHHS. Published July 2001. Revised October 2011. Retrieved February 2012.Slide112
References and Resources (Cont.)
http
://emedicine.medscape.com/article/1174630-overview
http://www.nytimes.com/interactive/2012/06/10/education/stimulants-student-voices.htmlhttp://www.chesterfieldsafe.orgwww.unifiedpreventioncoalition.comhttp://www.samhsa.gov/http://www.nida.nih.gov/nidahome.htmlhttp://www.suboxone.com
http://www.drugalcoholaddictionrecovery.com
http://drugpubs.drugabuse.gov/
http://www.whitehousedrugpolicy.gov/drugfact/juveniles/juvenile_drugs_ff.html
www.erowid.com
http://learn.genetics.utah.edu/content/addiction/
http://www.theantidrug.com/drug-information/default.aspxSlide113
Additional References and Resources
http
://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf
“Epidemic: Responding to America’s Prescription Drug Crisis” http://www.drugabuse.gov/publications/principles-drug-addiction-treatment “Principles of Drug Addiction Treatment: A Research-Based Guide (3rd Edition) http://www.drugabuse.gov
http://www.youtube.com/watch?v=E0ihO1KFxkQ
“Students Seek Competitive Edge…”
http://www.youtube.com/watch?v=1gQNg2f15dk
“Adderall: The Study Pill
”
http://www.youtube.com/watch?v=1sdFRJtzI0s
“PBS
NewsHour
Excerpt:Prescription
Drug Abuse (aired 5/2013)
http://www.youtube.com/watch?v=_mgQHSCDswQ&NR=1&feature=fvwp
“Prescription Drug Abuse”
http://www.nytimes.com/interactive/2012/06/10/education/stimulants-student-voices.html?emc=eta1#/#1
“In Their Own Words: Study Guides.”